The ‘men’ in mental health: “We need to talk and make fewer judgements”

In the third of our Men’s Mental Health series, medical cannabis patient, Jack Pierce, who has a diagnosis of ADHD, autism and anxiety, speaks about mental health, cannabis and why there needs to be less judgement for men.

Read the first and second of our men and mental health series here.

It’s always difficult to know exactly how bad the problem with mental health actually is, as a lot of the cases go undiagnosed and  unreported. This is especially true for men, who often find it difficult to talk about mental health.

Mental health access

Men are less likely to access psychological therapies than women, according to The Mental Health Foundation. Only 36 per cent of referrals to the NHS talking therapies are men. As a result, men may resort to other more dangerous ways of coping with mental health strain, such as drinking, drugs or violence. Men also have higher rates of homeless and are nearly three times as likely as women to become dependent on alcohol.

There are many reasons why men may choose to stay quiet when it comes to accessing help. In this series, the same themes were raised repeatedly as men reported feeling pressure to be dependable and to be seen as strong. Many also felt that there was little or no help from support services, community groups or even discussion among other men or male patients. This often left them feeling alone, vulnerable and in some cases, at risk.

This silence can be deadly. The Mental Health Foundation reported that in 2018, there were 6,507 suicides of which men accounted for three-quarters of that figure. This has remained relatively unchanged since the mid-90s.

Another issue when it comes to treating mental health is comorbidity, especially when it comes to neurological conditions.

Depression is more than two times higher in those with Attention Deficit Hyperactive Disorder (ADHD). And those on the autistic spectrum will find that they have higher levels of anxiety than neurotypical people.

One in five people are considered neurodiverse with a condition such as autism, ADHD, Tourettes, dyslexia, dyspraxia or obsessive-compulsive disorder.

Jack was diagnosed with chronic anxiety and depression as a teenager before his doctors reassessed him for autism and ADHD.

“I found out that my chronic anxiety and depression was actually ADHD and autism, so I got a diagnosis of both with combination ADHD. Everything changed but the depression and anxiety stayed,” said Jack.

“I tried cannabis recreationally and it helped me. I started on the legacy market before moving into the legal market. It’s difficult because I think a lot of the time, my ADHD and anxiety were masked by cannabis.

“When I got older, it became [more] difficult to mask, it’s impossible as a brain can’t mask for that many years.”

Masking can refer to two different things when it comes to ADHD or autism. Cannabis may offer relief from the constant, intense thought process of ADHD, helping to soothe or mask symptoms. It may also offer relief for those with autism.

Masking can also mean the practice of hiding ADHD or autistic traits to fit in with the neurotypical world. It can be exhausting and also traumatic for patients to do, as it takes more energy to monitor their behaviour. It can also be subconscious as patients learn to mimic the behaviour of others and get into patterns or routines based on what they have learned.

Jack Pierce

Mental health medication

When Jack started university, his supervisors began to notice different traits, along with his exceptional grades.

“People at university started to notice different things about me,” he said.

“I went from high school straight to university and got firsts which people don’t normally do. They thought there was something different about me and wanted to look into it.”

He added: “A lot of it was pushed on anxiety and anti-depressants. I took a lot of different medication to try to solve that which didn’t go well at all and it affected the diagnosis of ADHD.”

Jack was given different medications to try which had various side effects. It can be a difficult balancing act to prescribe the right medication for ADHD when a person also has depression and anxiety or autism.

Different symptoms from various conditions can make it a balancing act to find the correct mix for each individual person. Prescription drugs can encourage a variety of dangerous or unpleasant side effects in the meantime.

Jack stressed that while he needed medication, the tablets he was prescribed made him feel ill.

“For my anxiety, I was given propranolol and then was taken off that within three days of being prescribed because I get bad heart palpitations and arrhythmia issues. It felt as if my heart was going to explode, it was causing too much pressure,” said Jack.

“I was prescribed SSR inhibitors such as sertraline and citalopram. All of those made me withdrawn, gave me night terrors and sweats. I couldn’t function and would get really upset. I wouldn’t be able to live but then without them, I would get really unwell from depression. There were some moments of complete fallout and burnout where I was lost and I needed medication.”

Jack’s night terrors that felt so real he would wake up feeling emotional and stressed.

“I would wake up in puddles of sweat, quite emotional and stressed,” he said.

“I was given hydro-paroxetine to help me get some sleep which is quite an addictive drug to be prescribed. I didn’t want to take it because I would sleep and wake up feeling like I had missed a million hours. I couldn’t function. My autism and ADHD mean sleep medication is not a good thing to be consuming because it slows me down.”

Mental health and ADHD

Jack is now prescribed Elevanse and medical cannabis.

Elevanse is a stimulant drug often prescribed to treat ADHD in the UK. The capsules work on the parts of the brain that govern self-control and attention while helping to regulate them.  It is thought to reduce impulsive behaviour while increasing attention and concentration which ADHD patients can struggle with. Side effects can include headaches, weight loss, dry mouth, dizziness and feeling sick.

Jack decided to access a medical cannabis prescription to help with his mental health and after he became frustrated with the legacy market.

“When you are a patient using a legacy market, you are not prioritised or cared for,” he said.

“If you wake up one morning needing your medication, it may not be there and then accessing it is not always the easiest as you have to rely on other people to get it. Your mental health starts to fall because you aren’t getting treatment and having to go through that process is anxiety-inducing. I needed this plant to function.”

Jack continued: “I found out I could get a legal prescription through forums and decided to go for it. I reached out to try and improve my mental health. If I had been aware of the legal market before then I would have been able to get prescribed oils and would have been able to take a different approach, which may have improved my mental health and improved my disability.”

Medical cannabis is the last resort for a lot of patients due to the lack of education, stigma and reluctance of healthcare professionals to prescribe it. While cannabis has gained more media attention for conditions such as epilepsy or chronic pain, it is still not as well known for conditions such as ADHD or anxiety. A lot of patients find out about prescriptions by chance, the internet or family and friends, rather than healthcare workers.

University support

Universities in general are unsure how to deal with the issue of cannabis patients, as blanket drug bans mean there are usually no provisions for legal prescription holders. It’s yet another area where more cannabis education is badly needed.

Jack highlighted that there are students who are less inclined to speak publicly about medical cannabis in university. There are also many students who may risk being taken advantage of and wasting their student finance on cannabis through illegal markets.

“My university is not very supportive as I’m the first patient they have ever encountered,” he said.

“They don’t know how to advise me on taking my medication on campus, they don’t want me setting up societies because it’s advertising what is seen as illicit products. It’s still early days though and hopefully, with more conversations, we will get there.”

The figures for depression and anxiety amongst university students is also high, especially post lockdown. The Office of National Statistics estimates that one-third of students who started university in autumn 2021 are suffering from depression with 39 per cent showing symptoms of anxiety.

When it comes to mental health though, Jack said the university is incredibly supportive.

“It’s amazing. They run CBT therapy, psychologists and taught sessions. I have a weekly session with an advisor who I can talk to about anything. They write up notifications that say I can’t be spoken to off-guard in case I stutter or get nervous. That I might leave lectures at times due to stress. They make it a nice open communication with the whole university that I don’t have to partake in as they do it all,” he said.

“It’s nice to have that support daily and feel that I can go there, especially as a male. It’s difficult to say when we struggle and that I need help right now. I’ve never felt I can’t go to the mental health team at university and ask for help. That’s a credit to them.”

Creating change

So, where does Jack think the difficulties for men disclosing mental health struggles come from?

“I think it’s a fear of being judged. The anxiety of worrying if people still view me the same,” he said.

“I’m the only male in my family, so if I get upset, it’s like I’m the oldest son who shouldn’t be crumbling. But I do and it happens. A lot of us hide it and try to put a brave face on, mask it and keep going. At times it becomes really impossible.”

Male environments and friend groups may also make it difficult, as Jack explained: “When we are in environments around males they can just say ‘get over it’. They don’t get it and think it’s just a bad night but there are times I’ve been really upset. It’s not open for us to speak out about things. It can become really difficult and overwhelming for us.”

While there is a general acceptance and understanding that change needs to happen when it comes to encouraging men to speak out about mental health, there also needs to be spaces where they feel safe to do so. It can feel that change is coming but it is a slow process.

“We live in a really difficult time. If we could drop some judgement and understand that we are all human, if that could be shown towards men then maybe we will start to open up, share our lowest moments and know it’s okay to be upset,” said Jack.

“A lot of men worry that they may lose everything they have worked for. We need to educate men that if we go through these processes, we are still the same person that we were a few weeks ago.”

He added: “I’m not great sometimes but I’m still better for knowing this than hiding it away and pretending it’s all okay. We need to just talk and make fewer judgements.”

You can read last week’s article on men and mental health here